title: Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model.
abstract: OBJECTIVE
  To evaluate the effect of addition of nitrous oxide (N2O) to the carbon dioxide (CO2) pneumoperitoneum (PP) and the effect of blood, plasma, or red blood cells (RBCs) on postoperative adhesions in a laparoscopic mouse model.
  
  
  METHODS
  Prospective randomized controlled trial.
  
  
  METHODS
  University laboratory research center.
  
  
  METHODS
  BALB/c female mice.
  
  
  METHODS
  The effect of adding to the 60-minute CO2 PP 5%, 10%, 25%, 50%, or 100% N2O on adhesion formation was evaluated. Subsequently the effect of adding 1 mL blood, or RBCs, or plasma and the effect of adding different concentrations of blood were studied. Finally, the effect of adding 10% N2O, 4% O2, or both to the CO2 was evaluated in a control group and after addition of blood.
  
  
  METHODS
  Postoperative adhesions after 7 days.
  
  
  RESULTS
  N2O strongly reduces adhesion formation with a full effect at a concentration of 5% or 10%. Adhesions increase linearly with 0.125 mL to 1 mL blood. In both the control group and after adding blood, 10% N2O is the most effective factor in prevention of adhesions.
  
  
  CONCLUSIONS
  N2O, from concentrations of 5% upward, strongly prevents adhesion formation. Blood, mainly the plasma, increases adhesion formation. These data extend the concept of the role of acute inflammation and support the importance of good surgical practice with little bleeding and peritoneal cavity conditioning in adhesion prevention.
authors.affiliation: Centre for Reproductive Medicine, Free University Brussels, Brussels, Belgium. Electronic address: roberta.corona@uzbrussel.be.
authors.forename: Roberta
authors.initials: R
authors.lastname: Corona
authors.forename: Maria Mercedes
authors.initials: MM
authors.lastname: Binda
authors.forename: Karina
authors.initials: K
authors.lastname: Mailova
authors.forename: Jasper
authors.initials: J
authors.lastname: Verguts
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Koninckx
mesh_terms: D000818:Animals; D001803:Blood Transfusion / Q000379:methods; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D006801:Humans; D010535:Laparoscopy; D051379:Mice; D008807:Mice, Inbred BALB C; D009609:Nitrous Oxide / Q000008:administration & dosage*; D012188:Retropneumoperitoneum / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D002245:Carbon Dioxide; D009609:Nitrous Oxide
keywords: N(2)O; O(2); Pneumoperitoneum; adhesions; bleeding; laparoscopy; peritoneal conditioning